History of emergency nursing

It could be said that in any age we can see the beginnings of emergency care and emergency nursing. But if we take on board comments made at the beginning of the 19th century when nursing was regarded as an inferior, disagreeable and repellent form of domestic service, it is perhaps wise not to go too far back for our roots.

In the 1800's as hospitals become more popular so emergency care grew and many people would sit for hours waiting for treatment. Unless you were dying, and even then you may have to wait, the general rule of thumb was first come first served. This situation was intolerable and hence one of our major emergency care advancements and one we should celebrate came about - triage.

Triage while having been used in war for centuries had not been established in the emergency department. The first reference to triage during non-disaster activity was in 1963 at Yale, Newhaven hospital USA. However if we look further back to a lecture given by Sir D'Arcy Power in Glasgow in 1898 describing the casualty department at St Bartholomews hospital London we find that at 8.30am patients began to assemble on the steps but were not allowed in until the last stroke of nine.

The doors were then opened to allow one patient at a time to enter and the nurse asked the patient what was the complaint and then referred the person to either the physician or surgeon as was thought fit. The diagnosis was rough and unskilled but usually correct. While triage was not immediately recognised as a nursing role it is now firmly the nurse's remit and continues to be developed.

While emergency nursing has grown over the centuries the last 35 years have seen the most profound changes especially in the position that emergency nurses now hold. Perhaps that persistence comes from the founder of modern nursing. Florence Nightingale's role in the Crimea certainly puts her into the category of an emergency nurse and the establishment of a nurse training school in London in 1860 started the development of modern nursing as we know it today.

One of the key success stories of emergency nursing and another major celebration milestone has to be the emergence of emergency nursing groups. Since the early seventies many countries have developed national organisations, spreading the word and professionalism of emergency nurses.

When we look through our history we find numerous areas that we can truly celebrate, the development of resuscitation standards, care of rape victims, campaigning for health care legislation, pre hospital care, care of children, the elderly and psychiatric care in emergency departments all areas to be proud of.

A tremendous amount of work has been undertaken in the care of suddenly bereaved relatives. Many nurses have developed standards for this aspect of our work. Many follow up the relatives with telephone calls and on going short term support.

Trauma care is another area that I wish to focus on. Care in the past was not as organised as it is now. It was a bit of a free for all and certainly required attention.

The Trauma Nursing Core Course is truly an international course. While having its roots and base in the US, the international faculty makes it a true world-wide course that provides standards internationally for trauma nursing. TNCC is now in a number of countries across the Globe.

Emergency Nurse Practitioners: During the last 20 years nurses have constantly pushed forward the boundaries and have developed emergency nursing not only to improve patient care but also to reduce waiting time. The Emergency Nurse Practitioners in the emergency department and minor injuries units have achieved this new role and now many patients are treated and discharged having seen the best person for their problem - the emergency nurse.

The International Conference: The first ever international emergency nursing conference was held in 1985 in London. That first conference found many emergency nurses from all over the world coming together for the first time. In fact there were over 600 delegates representing 28 different countries.

Reflecting on our international links also reminds us not to forget but rather celebrate the large numbers of emergency nurses who work across national boundaries helping fellow emergency nurses in other countries. Many emergency nurses work for international organisations and so professionally give their all to deal with disasters in all its guises. Many thanks from us all.

So what has happened in the 1990's? Well a tremendous amount and this can be seen in the developments of key areas that were established in the 1970's and 80's. Development of triage, care of bereaved relatives, child care, psychiatric care, pre hospital care and many more. What for me the nineties have done is polished the groundwork that was started.

Education and research has taken all the work forward in leaps and bounds. No longer is it acceptable to assume things work. It must be proven through research and then be available to all through a proper educational program.

Another key success of the nineties has to be the way nurses, doctors and therapists are more relaxed and working in a much more collaborative way, the co-operation and multi-disciplinary working has almost replaced the hostility and territorial boundaries of the 1970's and 80's.

So let us all continue to celebrate emergency nursing because emergency nursing is simply the best.